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Acute Lymphoblastic Leukemia and Invasive Mold Infections: A Challenging Field. J Fungi (Basel) 2022; 8:jof8111127. [DOI: 10.3390/jof8111127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) patients comprise a highly immunocompromised group due to factors associated either with the treatment or the disease itself. Invasive mold infections (IMIs) are considered to be responsible for higher morbidity and mortality rates in patients with hematologic malignancies, including ALL. Defining the exact incidence of IMIs in ALL patients has been rather complicated. The available literature data report a highly variable incidence of IMIs, ranging from 2.2% to 15.4%. Although predisposing factors for IMIs in the setting of ALL are ill-defined, retrospective studies have indicated that a longer duration of neutropenia, treatment with high-dose corticosteroids, and a lack of antimold prophylaxis are associated with an increased risk of IMIs. Additionally, the influence of novel ALL treatments on the susceptibility to fungal infections remains obscure; however, initial data suggest that these treatments may induce prolonged neutropenia and thus an increased risk of IMIs. Administering primary antimold prophylaxis in these patients has been challenging since incorporating azole antifungal agents is troublesome, considering the drug-to-drug interactions (DDIs) and increased toxicity that may occur when these agents are coadministered with vincristine, a fundamental component of ALL chemotherapy regimens. Isavuconazole, along with several novel antifungal agents such as rezafungin, olorofim, and manogepix, may be appealing as primary antimold prophylaxis, given their broad-spectrum activity and less severe DDI potential. However, their use in ALL patients needs to be investigated through more clinical trials. In summary, this review outlines the epidemiology of IMI and the use of antifungal prophylaxis in ALL patients.
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Pourbaix A, Lafont Rapnouil B, Guéry R, Lanternier F, Lortholary O, Cohen JF. Smoking as a Risk Factor of Invasive Fungal Disease: Systematic Review and Meta-Analysis. Clin Infect Dis 2021; 71:1106-1119. [PMID: 31900476 DOI: 10.1093/cid/ciaa001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/01/2020] [Indexed: 01/23/2023] Open
Abstract
To investigate the association between smoking and invasive fungal disease (IFD), we searched MEDLINE and Web of Science for studies published until September 2018. Two authors independently performed study selection and data extraction. Relative risks (RRs) were pooled using random-effects meta-analysis. We included 25 studies (18 171 participants; 2527 IFD cases). The meta-analysis showed an increased risk of IFD in smokers (RR 1.41 [95% confidence interval 1.09-1.81]; P = .008). The risk of IFD was higher in retrospective than in prospective studies (RR 1.93 [1.28-2.92] vs. 1.02 [0.78-1.34]; P = .04), in studies with multivariate adjustment compared to studies with univariate analysis (RR 2.15 [1.27-3.64] vs. 1.15 [0.88-1.51]; P = .06), and in studies published after 2002 (RR 2.08 [1.37-3.15] vs. 0.95 [0.75-1.22]; P = .008); other subgroup characteristics did not significantly influence the association in metaregression. Smoking cessation strategies should be implemented, especially in patients who are already at risk for IFD.
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Affiliation(s)
- Annabelle Pourbaix
- Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Necker-Enfants malades Hospital, APHP, Paris University, Sorbonne Paris Cité, Imagine Institute, Paris, France
| | - Baptiste Lafont Rapnouil
- Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Necker-Enfants malades Hospital, APHP, Paris University, Sorbonne Paris Cité, Imagine Institute, Paris, France
| | - Romain Guéry
- Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Necker-Enfants malades Hospital, APHP, Paris University, Sorbonne Paris Cité, Imagine Institute, Paris, France
| | - Fanny Lanternier
- Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Necker-Enfants malades Hospital, APHP, Paris University, Sorbonne Paris Cité, Imagine Institute, Paris, France.,Institut Pasteur, Molecular Mycology Unit, National Reference Center for Invasive Mycoses and Antifungals, UMR, CNRS, Paris, France
| | - Olivier Lortholary
- Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Necker-Enfants malades Hospital, APHP, Paris University, Sorbonne Paris Cité, Imagine Institute, Paris, France.,Institut Pasteur, Molecular Mycology Unit, National Reference Center for Invasive Mycoses and Antifungals, UMR, CNRS, Paris, France
| | - Jérémie F Cohen
- Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Necker-Enfants malades Hospital, APHP, Paris University, Sorbonne Paris Cité, Imagine Institute, Paris, France.,Inserm U1153, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Paris, France
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Boğa C, Bolaman Z, Çağırgan S, Karadoğan İ, Özcan MA, Özkalemkaş F, Saba R, Sönmez M, Şenol E, Akan H, Akova M. Recommendations for Risk Categorization and Prophylaxis of Invasive Fungal Diseases in Hematological Malignancies: A Critical Review of Evidence and Expert Opinion (TEO-4). Turk J Haematol 2017; 32:100-17. [PMID: 26316478 PMCID: PMC4451478 DOI: 10.4274/tjh.2014.0277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This is the last of a series of articles on invasive fungal infections prepared by opinion leaders in Turkey. The aim of these articles is to guide clinicians in managing invasive fungal diseases in hematological malignancies and stem cell transplantation based on the available best evidence in this field. The previous articles summarized the diagnosis and treatment of invasive fungal disease and this article aims to explain the risk categorization and guide the antifungal prophylaxis in invasive fungal disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Hamdi Akan
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey Phone: +90 532 424 26 40 E-mail:
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Douglas AP, Slavin MA. Risk factors and prophylaxis against invasive fungal disease for haematology and stem cell transplant recipients: an evolving field. Expert Rev Anti Infect Ther 2016; 14:1165-1177. [PMID: 27710140 DOI: 10.1080/14787210.2016.1245613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Due to increasing intensity and complexity of therapies and longer survivorship, many patients with haematologic malignancy (HM) are at risk of invasive fungal disease (IFD). Mortality from IFD is high and treatment of an episode of IFD results in an excess length of hospital stay and costs and delays delivery of curative therapy of the underlying haematologic condition. Therefore, prevention and early recognition and treatment of IFD are crucial. Areas covered: Risk factors particular to certain HMs and haematopoietic stem cell transplantation, as well as those risk factors universal to all HM groups are examined. Expert commentary: Risk stratification identifies those patients who would benefit most from mould active versus yeast active prophylaxis and those who can be safely managed with monitoring and clinically driven interventions for IFD. This approach aids in antifungal stewardship.
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Affiliation(s)
- Abby P Douglas
- a Department of Infectious Diseases , Peter MacCallum Cancer Centre , Melbourne , VIC , Australia
| | - Monica A Slavin
- a Department of Infectious Diseases , Peter MacCallum Cancer Centre , Melbourne , VIC , Australia.,b Victorian Infectious Diseases Service , Royal Melbourne Hospital , Melbourne , VIC , Australia.,c Department of Medicine , University of Melbourne , Melbourne , VIC , Australia
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Caira M, Latagliata R, Girmenia C. The risk of infections in patients with myelodysplastic syndromes in 2016. Expert Rev Hematol 2016; 9:607-14. [PMID: 27100058 DOI: 10.1080/17474086.2016.1181540] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The medical treatment of patients suffering from myelodysplastic syndromes has significantly changed during the last ten years, and this may have impacted the epidemiology of infectious complications. Some 'real world' experiences raised the issue of infections in this setting and the possible negative consequences for patients and health system: the higher the rate of hospitalizations and need for anti-infective therapies, the higher the treatment delays/withdrawal and consecutive the worse the outcome. AREAS COVERED The main epidemiological data on myelodysplastic patients are reviewed. Potential risk factors are described, including those related to the disease itself, patient's characteristics, health conditions and the environment. Expert commentary: The complexity of MDS treatment is expected to increase further, with the introduction of other drugs and combined therapies. Defining the level of risk at time of treatment prescription will become more and more important, in order to better manage the infectious risk and the febrile events eventually occurring.
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Affiliation(s)
| | - Roberto Latagliata
- b Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I , 'Sapienza' Università of Rome , Rome , Italy
| | - Corrado Girmenia
- b Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I , 'Sapienza' Università of Rome , Rome , Italy
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Caira M, Candoni A, Verga L, Busca A, Delia M, Nosari A, Caramatti C, Castagnola C, Cattaneo C, Fanci R, Chierichini A, Melillo L, Mitra ME, Picardi M, Potenza L, Salutari P, Vianelli N, Facchini L, Cesarini M, De Paolis MR, Di Blasi R, Farina F, Venditti A, Ferrari A, Garzia M, Gasbarrino C, Invernizzi R, Lessi F, Manna A, Martino B, Nadali G, Offidani M, Paris L, Pavone V, Rossi G, Spadea A, Specchia G, Trecarichi EM, Vacca A, Cesaro S, Perriello V, Aversa F, Tumbarello M, Pagano L. Pre-chemotherapy risk factors for invasive fungal diseases: prospective analysis of 1,192 patients with newly diagnosed acute myeloid leukemia (SEIFEM 2010-a multicenter study). Haematologica 2015; 100:284-92. [PMID: 25638805 DOI: 10.3324/haematol.2014.113399] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Correct definition of the level of risk of invasive fungal infections is the first step in improving the targeting of preventive strategies. We investigated the potential relationship between pre-hospitalization exposure to sources of fungi and the development of invasive fungal infections in adult patients with newly diagnosed acute myeloid leukemia after their first course of chemotherapy. From January 2010 to April 2012, all consecutive acute myeloid leukemia patients in 33 Italian centers were prospectively registered. Upon first admission, information about possible pre-chemotherapy risk factors and environmental exposure was collected. We recorded data regarding comorbid conditions, employment, hygienic habits, working and living environment, personal habits, hobbies, and pets. All invasive fungal infections occurring within 30 days after the first course of chemotherapy were recorded. Of the 1,192 patients enrolled in this study, 881 received intensive chemotherapy and were included in the present analysis. Of these, 214 developed an invasive fungal infection, including 77 proven/probable cases (8.7%). Of these 77 cases, 54 were proven/probable invasive mold infections (6.1%) and 23 were proven yeast infections (2.6%). Upon univariate analysis, a significant association was found between invasive mold infections and age, performance status, diabetes, chronic obstructive pulmonary disease, smoking, cocaine use, job, hobbies, and a recent house renovation. Higher body weight resulted in a reduced risk of invasive mold infections. Multivariate analysis confirmed the role of performance status, job, body weight, chronic obstructive pulmonary disease, and house renovation. In conclusion, several hospital-independent variables could potentially influence the onset of invasive mold infections in patients with acute myeloid leukemia. Investigation of these factors upon first admission may help to define a patient's risk category and improve targeted prophylactic strategies. (Clinicaltrial.gov: NCT01315925)
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Affiliation(s)
- Morena Caira
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma
| | - Anna Candoni
- Clinica Ematologica, Azienda Ospedaliero Universitaria di Udine
| | - Luisa Verga
- Unità di Ematologia, Università Milano Bicocca, Ospedale S.Gerardo, Monza
| | | | - Mario Delia
- Hematology and BMT Unit, Department of Emergency and Organ Transplantation, University of Bari, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari
| | - Annamaria Nosari
- Divisione di Ematologia e Centro Trapianti Midollo, Ospedale Niguarda Ca' Granda, Milan
| | | | - Carlo Castagnola
- Dipartimento Onco-Ematologico Fondazione ICRRS Policlinico San Matteo, Pavia
| | | | - Rosa Fanci
- Unità Funzionale di Ematologia, Azienda Ospedaliero-Universitaria Careggi e Università di Firenze
| | | | - Lorella Melillo
- Unità di Ematologia, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | | | - Marco Picardi
- Azienda Ospedaliera Universitaria Federico II Napoli, Dipartimento di Medicina Clinica e Chirurgia
| | - Leonardo Potenza
- Sezione di Ematologia, Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università di Modena e Reggio Emilia
| | | | - Nicola Vianelli
- Istituto di Ematologia ed Oncologia Clinica "Lorenzo e Ariosto Serágnoli", Ospedale S.Orsola-Malpighi, Università di Bologna
| | - Luca Facchini
- Divisione di Ematologia, Arciospedale S.Maria Nuova, Reggio Emilia
| | - Monica Cesarini
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma
| | | | - Roberta Di Blasi
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma
| | - Francesca Farina
- Unità di Ematologia, Università Milano Bicocca, Ospedale S.Gerardo, Monza
| | - Adriano Venditti
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma
| | | | | | | | - Rosangela Invernizzi
- Dipartimento di Medicina Interna, Università di Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Federica Lessi
- Ematologia ed Immunologia Clinica, Dipartimento di Medicina, Universita' di Padova
| | | | - Bruno Martino
- Divisione di Ematologia, Azienda Ospedaliera "Bianchi Melacrino Morelli", Reggio Calabria
| | - Gianpaolo Nadali
- UOC Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona
| | | | - Laura Paris
- Divisione di Ematologia e Centro Trapianti Midollo, Ospedale Niguarda Ca' Granda, Milan
| | | | | | - Antonio Spadea
- Unità di Ematologia, Istituti Fisioterapici Ospitalieri, Roma
| | - Giorgina Specchia
- Hematology and BMT Unit, Department of Emergency and Organ Transplantation, University of Bari, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari
| | | | | | - Simone Cesaro
- Emato-Oncologia Pediatrica, Azienda Ospedaliera Universitaria Integrata, Verona
| | - Vincenzo Perriello
- Istituto di Ematologia, Ospedale S. Maria della Misericordia, Università di Perugia, Italy
| | | | - Mario Tumbarello
- Istituto di Malattie Infettive, Università Cattolica del Sacro Cuore, Roma
| | - Livio Pagano
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma
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Akan H, Antia VP, Kouba M, Sinkó J, Tănase AD, Vrhovac R, Herbrecht R. Preventing invasive fungal disease in patients with haematological malignancies and the recipients of haematopoietic stem cell transplantation: practical aspects. J Antimicrob Chemother 2014; 68 Suppl 3:iii5-16. [PMID: 24155144 DOI: 10.1093/jac/dkt389] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Invasive fungal disease (IFD), predominantly aspergillosis, is associated with significant morbidity and mortality in immunocompromised patients, especially those with haematological malignancies and recipients of allogeneic haematopoietic stem cell transplantation. There has been a great deal of scientific debate as to the effectiveness of antifungal prophylaxis in preventing infection in different patient groups and in which patients it is an appropriate management option. Deciding on an appropriate prophylaxis regimen for IFD is challenging as the incidence varies among different patient groups, due to the varied nature of their underlying haematological disease, and in different regions and centres. Attempts have been made to define risk factors and include them in treatment protocols. Impaired immune status of the patient, especially neutropenia, is a key risk factor for IFD and can sometimes be related to specific polymorphisms of genes controlling innate immunity. Risk factors also vary according to the type of fungal pathogen. Consequently, prophylaxis needs to be tailored to individual patient groups. Furthermore, the choice of antifungal agent for prophylaxis depends on the potential for drug-drug interactions with the patients' concomitant medications. Additional challenges are optimal timing of antifungal prophylaxis, when to change from prophylaxis to antifungal treatment and how to prevent recurrence of IFD. This article considers the use of antifungal prophylaxis for patients at risk of IFD in daily clinical practice, with clinical profiles that may be distinct from those covered by guidelines, and aims to provide practical advice for treatment of these patient groups.
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Affiliation(s)
- Hamdi Akan
- Department of Hematology, Ankara University Medical Faculty, Ankara, Turkey
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Ariza-Heredia EJ, Kontoyiannis DP. Our recommendations for avoiding exposure to fungi outside the hospital for patients with haematological cancers. Mycoses 2014; 57:336-41. [PMID: 24446760 DOI: 10.1111/myc.12167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 12/16/2013] [Accepted: 12/14/2013] [Indexed: 11/27/2022]
Abstract
Despite several chemotherapeutic and preventative advances, opportunistic fungal infections remain common unintended consequences of cancer treatment. Currently, cancer patients spend most of their time between treatments at home, where they can inadvertently come across potential hazards from environmental and food sources. Therefore, infection prevention measures are of the utmost importance for these patients. Although clinicians closely observe patients throughout their treatment courses in the hospital, the focus of clinical visits is predominantly on cancer care, and clinicians seldom provide recommendations for prevention of such infections. Herein, we provide practical recommendations for busy clinicians to help them educate patients regarding potential sources of fungal infections outside the hospital.
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Affiliation(s)
- Ella J Ariza-Heredia
- Department of Infectious Diseases, Infection Control and Employee Health, Houston, TX, USA
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Auberger J, Lass-Florl C, Aigner M, Clausen J, Gastl G, Nachbaur D. Invasive fungal breakthrough infections, fungal colonization and emergence of resistant strains in high-risk patients receiving antifungal prophylaxis with posaconazole: real-life data from a single-centre institutional retrospective observational study. J Antimicrob Chemother 2012; 67:2268-73. [DOI: 10.1093/jac/dks189] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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